What is pregabalin?
Pregabalin, like gabapentin, is a medicine used to treat a variety of conditions including epilepsy, neuropathic pain (pain related to problems with nerve signals) and anxiety disorders.
Some people use pregabalin recreationally and consequently there is an illicit trade in this drug, including through online pharmacies.
Appearance
Pregabalin comes as white, yellow or orange tablets/capsules. They are normally swallowed, although powder from capsules may be snorted.
UK situation
A letter from the Advisory Council on the Misuse of Drugs sent to the government in January 2016 describes a review of the potential harms associated with the misuse of pregabalin and gabapentin. In the UK, pregabalin and gabapentin prescribing has increased by 350% and 150% respectively in 5 years.
In 2013, ten cases of recreational pregabalin abuse were presented to one Emergency Department in Belfast over the course of 2012/13 and the DrugScope Street Drug Survey (2014) reported that most areas covered by the survey highlighted significant use of these drugs, especially among Britain’s opioid-using and prison populations.
One drug worker in York told the survey:
“We’ve seen a big rise in the illicit use of pregabalin and gabapentin. The effects are horrendous and life threatening. People become so heavily intoxicated because they are mixing several drugs at a time. The drugs can reduce the heart rate and if taken with methadone can be extremely dangerous, so we now have to consider whether people are using these drugs when we prescribe methadone.
“Initially we had thought there was a batch of dodgy heroin with Rohypnol in it, but [we found instead that] they were using pregabalin and gabapentin alongside heroin. Often they don’t know what strength capsules they are taking because they look similar. Both drugs are readily available and certainly have a street value attached to them. We have sent a letter to GPs asking them not to prescribe it so much.”
Effects / risks
Pregabalin is a central nervous system depressant. As well as drowsiness and sedation, the effects can include euphoria and feeling more sociable, relaxed and calm. As mentioned above there are reports of people using the drug to enhance the effects of heroin and therefore reduce the amount of heroin needed.
Pregabalin may have a higher abuse potential than gabapentin due to its rapid absorption, faster onset and higher potency. Pregabalin causes a ‘high’ or elevated mood in users. Side effects can include chest pain, wheezing, vision changes and less commonly, hallucinations.
The drug can be dangerous, especially if used with other central nervous system depressants including opioids like heroin and methadone, as well as antidepressants, antihistamines, tranquillisers and alcohol.
The number of fatalities involving pregabalin and gabapentin is rising. In October 2015, the National Programme for Substance Abuse Deaths (npSAD) provided the ACMD with a breakdown of deaths associated with pregabalin and gabapentin. In 2013, there were 19 deaths implicated with pregabalin and 17 deaths implicated with gabapentin in the UK
Pregabalin can cause dependence.
For more information on pregabalin and gabapentin see this advice, aimed at prescribers, from Public Health England (PDF)
The law
Pregabalin and gabapentin are prescription only medicines and can only be prescribed following a consultation with a doctor.
On 1st April 2019, following an ACMD recommendation, both pregabalin and gabapentin are now controlled under the Misuse of Drugs Act 1971 as Class C substances.
See also our page on gabapentin